Outcome of 5,000 flexible sigmoidoscopies done by nurse endoscopists for colorectal screening in asymptomatic patients.

OBJECTIVES: There have been several studies to date establishing the efficacy of nurse endoscopists in colorectal screening. However, no such study has ever been conducted in Hawaii. Utilizing the large sample size of our study, we hope to further support endoscopy by nurses as both a safe and cost-effective means of screening for colon cancer.

METHODS: This is a retrospective study of the results of more than 5,000 flexible sigmoidoscopies done by nurse endoscopists in the colorectal screening clinic at Kaiser Hospital in Honolulu, Hawaii, between November 1995 and February 2001. These results were separated into normal, non-neoplastic polyps, adenomas, and cancer.

RESULTS: The rate of detection of polyps was 13.3% (non-neoplastic and adenomas). Colon cancer was detected in 15 patients (.3% detection rate), of which 8 were carcinoma in situ, 3 were Dukes A, 2 were Dukes B1/B2, and 2 were Dukes C2. Clinically significant lesions (i.e. carcinoma, large adenomas, or atypical adenomas) were found in 1.8% of all patients. There were 8 carcinoids, 1 lipoma, 2 condylomas, and 3 leiomyomas detected. For patients who underwent colonoscopy, no other significant lesions were found in the areas examined by nurse endoscopists. There were no complications, i.e. perforation, bleeding, infection, and death, in any of the patients.

CONCLUSION: The results of our study emphasize the importance of being screened for colorectal cancer. Nurse endoscopists can safely and effectively perform screening flexible sigmoidoscopies. By training more nurse endoscopists, we can increase the rate of colorectal screening in a cost-effective manner.